Issue: Spring 2019 Vol. 14 - Issue 1
      
 
From the Editor's Desk 
Are There Any Solutions to the High Cost and Shortages of Drugs?
– Lawrence I. Bonchek, MD, FACS, FACC
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Top Tips from Family Practice 
Choosing Wisely XXVII: Recommendations on Pediatric Infectious Diseases, Blood Management, and Dermatopathology
– Alan S. Peterson, M.D.
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Scientific Reports 
Spotlight on Ciinical Research: Nephrology, Cardiology, Radiology, Neurology
– Roy S. Small, M.D., and Heather Madara
The clinical research studies at PMLGH that are spotlighted in this issue focus on anemia in renal disease and/or heart failure; remote monitoring of patients with heart failure; noninvasive measurement of left ventricular function; assessment of coronary disease severity with computed tomography; and anticoagulation to prevent stroke in subclinical atrial fibrillation.
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Extracorporeal Membrane Oxygenation (ECMO)
– 
Mark J. Epler, M.D.
ECMO is no longer an experimental therapy, but is now an essential component of care for patients with respiratory or cardiac failure for temporary support during recovery, or for transition to permanent therapies such as transplantation or durable mechanical support. This review of the methodology also reports on the considerable experience at PMLGH since the program began in 2012.
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Urgent Care: Meeting a Growing Demand
– Susan Wynne, Stacey Lee Harris, Vito J. DiCamillo, M.D.
This is the first of a two-part series on the leading role of PMLGH in the explosive growth of Urgent Care in Lancaster County. It details the factors fueling that growth, the demographics of patients who seek its services, its impact on utilization of the Emergency Department, and its prospects for the future. A future article will examine clinical aspects of PMLGH’s UC model.
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Doctors of Nursing Practice: What Is Their Role and What Education Do They Require?
– 
Annmarie Blair, DNP, MSN, BSN, RN
The American Association of Colleges of Nursing first defined the Doctor of Nursing Practice degree in 2004. Unlike the better-known PhD, which emphasizes research to develop new knowledge for the science of nursing, the doctorate in advanced nursing practice focuses on translating nursing research into evidence-based standards of care and practice. This report examines the education, qualifications, and multiple potential roles of nurses with this degree.
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Barriers to Behavioral Health Treatment: Changing the Conversation
– Jayne Van Bramer, M.S., M.A., B.A.
Notwithstanding continuing controversy about the indications and effectiveness of medical marijuana (MM), the 2016 Pennsylvania Medical Marijuana Act established a legal state process for patients to obtain MM. Still, it omits crucial guidelines, protections, and parameters for both patients and providers, and – like other state laws legalizing MM – it is inconsistent with federal prohibitions. This article discusses legal quandaries surrounding the prescription and use of MM that providers must know about.
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